Dysphagia In Patients Research Articles

Influences of food hardness on the particle size distribution of food boluses

ObjectivesBolus swallowing or deglutition is a vital oral action which transports orally processed food from the oral cavity to the stomach for further digestion. Swallowing is routine to most health individuals, but it could be highly hazardous to many elderly and dysphagia patients. In order to provide proper food for safe consumption by these disadvantaged populations, a fundamental understanding of how bolus swallowing is triggered and is based on what criteria is urgently needed. Main objective of this work was to understand the physical properties of food boluses, in particular the bolus particle size distribution in relation to the hardness of the food. MethodsFood samples were chewed in free style by subjects and boluses were expectorated when subjects felt they were ready to be swallowed. Altogether seven different types of food were used and 10 health subjects participated in this study. Bolus particles were carefully washed and spread out on a flat surface. Images of bolus particles were taken using a digital camera and analysed using Image Pro Plus software for particle size quantification. Food hardness was measured using a Texture Analyser by a puncture test. ResultsIt was observed that bolus particle size decreased with the increase of food hardness. The correlation between the two properties can be described by a power-law relationship. This relationship was also found applicable to literature results reported by Peyron et al. and Jalabert-Malbos et al. ConclusionsFood hardness has a direct influence on its bolus particle size. The harder the food, the smaller the bolus particle size.

Diagnosis and treatment of post-extubation dysphagia: Results from a national survey

PurposeThis study sought to determine the utilization of speech-language pathologist (SLPs) for the diagnosis and treatment of post-extubation dysphagia in survivors of mechanical ventilation. MethodsWe designed, validated, and mailed a survey to 1,966 inpatient SLPs who routinely evaluate patients for post-extubation dysphagia. ResultsMost SLP diagnostic evaluations (60%; 95% CI, 59%-62%) were performed using clinical techniques with uncertain accuracy. Instrumental diagnostic tests (such as fluoroscopy and endoscopy) are more likely to be available at university than community hospitals. After adjusting for hospital size and academic affiliation, instrumental test use varied significantly by geographical region. Treatments for post-extubation dysphagia usually involved dietary adjustment (76%; 95% CI, 73-79%) and postural changes/compensatory maneuvers (86%; 95% CI, 84-88%), rather than on interventions aimed to improve swallowing function (24%; 95% CI, 21-27%). ConclusionsSLPs frequently evaluate acute respiratory failure survivors. However, diagnostic evaluations rely mainly upon bedside techniques with uncertain accuracy. The use of instrumental tests varies by geographic location and university affiliation. Current diagnostic practices and feeding decisions for critically ill patients should be viewed with caution until further studies determine the accuracy of bedside detection methods.

Indications for gastrostomy feeding in Polish children—Multicenter retrospective analysis of ten years period (2000–2010)

Introduction: The aim of the study was to analyze retrospectively the indications for gastrostomy in Polish children. Six medical centers which have been providing enteral nutrition participated in this study. Methods: Available medical records of children in whom the first gastrostomy was placed between 2000 and 2010 were analyzed in terms of: source and indications for gastrostomy admission, nutritional status and feeding mode preceding gastrostomy placement. Results: The analyzed group comprised of 349 children (57% males, 43% females). The mean age at first gastrostomy placement was 6.2±7.4 years. 163 (46.7%) patients were fed orally and 186 (53.7%) patients received enteral nutrition via nasogastric tube before gastrostomy placement. The mean duration of nasogastric tube feeding before gastrostomy insertion amounted 37.6±54.6 weeks. Body weight of most patients (278/78%) before gastrostomy placement was under the third percentile for age. Neurological impairment was present in 293 (84%) of cases. The most common indications for gastrostomy administration included dysphagia (259/74%) patients) and malnutrition (62/18%). Other indications were: necessity to increase energy intake (14/4% of cases), terminal care in hospice patients (11/3%) and gastrostomy as a transfer from parenteral to enteral nutrition in 3 cases. Based on medical records percutaneous endoscopic gastrostomy (PEG) was performed in 258/74% children, 80/23% patients underwent surgical procedure, and there was lack of data in 11 cases. Conclusion: The main indication for pediatric gastrostomy in Polish sites was neurological disorders with dysphagia. Malnutrition was reported in most of children before gastrostomy placement.

A Unique Case of Systemic Sarcoidosis Presenting as Pseudoachalasia with Involvement of the Gastric Cardia

Background: A 59-year-old African American male presented to the Gastroenterology Clinic with a nine month history of solid food dysphagia. Endoscopy revealed nodular erythematous tissue at the gastric cardia, biopsies showed noncaseating granulomas. Chest imaging demonstrated bilateral hilar lymphadenopathy, confirming the diagnosis of systemic sarcoidosis, and oral corticosteroid therapy was initiated. High-resolution manometry showed incomplete relaxation of the lower esophageal sphincter consistent with possible achalasia. Further evaluation with EUS showed paraesophageal lymphadenopathy causing extrinsic esophageal compression. The patient's dysphagia responded to serial esophageal dilations, however, he was referred to surgery for consideration for cardiomyotomy or lymphadenectomy as a definitive treatment. Discussion: Gastric involvement in patients with systemic sarcoidosis has been reported in 2.5% of cases. Although our patient developed granulomatous involvement of the gastric cardia, it is the gastric antrum that is most frequently affected. To our knowledge only one case of pseudoachalasia due to gastric cardia sarcoidosis has been previously reported, and was successfully treated with cardiomyotomy. Sarcoidosis has been implicated as a cause of pseudoachalasia in roughly 2-4% of symptomatic patients with a manometric pattern of primary achalasia. Previous reports have described dysphagia symptoms from mechanical compression by lymphadenopathy or granulomatous infiltration of the mucosal musculature and nerve fibers. Multiple cases of esophageal sarcoidosis have been reported in the literature; some of which responded to medical management with corticosteroid therapy, endoscopic dilations, or botulinum toxin injections. Definitive surgical interventions in the form of cardiomyotomy or lymphadenectomy will be pursued should the patient's symptoms become refractory to medical management. Conclusion: To our knowledge, our patient is the second reported case of pseudoachalasia secondary to gastric cardia sarcoidosis. Surgery has been suggested for patients with esophageal and gastric sarcoidosis in the form of cardiomyotomy or lymphadenectomy to patients refractory to medical management. Our patient, however, has responded to a combined medical and endoscopic approach.Figure: No Caption available.

Effect of Bolus Volume and Viscosity on Pharyngeal Automated Impedance Manometry Variables Derived for Broad Dysphagia Patients

Automated impedance manometry (AIM) analysis measures swallow variables defining bolus timing, pressure, contractile vigour, and bolus presence, which are combined to derive a swallow risk index (SRI) correlating with aspiration. In a heterogeneous cohort of dysphagia patients, we assessed the impact of bolus volume and viscosity on AIM variables. We studied 40 patients (average age=46years). Swallowing of boluses was recorded with manometry, impedance, and videofluoroscopy. AIMplot software was used to derive functional variables: peak pressure (PeakP), pressure at nadir impedance (PNadImp), time from nadir impedance to peak pressure (TNadImp-PeakP), the interval of impedance drop in the distal pharynx (flow interval, FI), upper oesophageal sphincter (UES) relaxation interval (UES RI), nadir UES pressure (Nad UESP), UES intrabolus pressure (UES IBP), and UES resistance. The SRI was derived using the formula SRI=(FI*PNadImp)/(PeakP*(TNadImp-PeakP+1))*100. A total of 173 liquid, 44 semisolid, and 33 solid boluses were analysed. The SRI was elevated in relation to aspiration. PeakP increased with volume. SRI was not significantly altered by bolus volume. PNadImp, UES IBP, and UES resistance increased with viscosity. SRI was lower with increased viscosity. In patients with dysphagia, the SRI is elevated in relation to aspiration, reduced by bolus viscosity, and not affected by bolus volume. These data provide evidence that pharyngeal AIM analysis may have clinical utility for assessing deglutitive aspiration risk to liquid boluses.

Healthcare foodservice workers' knowledge of the dysphagia diet

PurposeThe purpose of this paper is to survey current nutrition/foodservice‐related healthcare professionals to determine their level of knowledge about dysphagia, and their perceptions of dysphagic patients and their needs.Design/methodology/approachA data collection instrument in the form of a questionnaire was developed to obtain an idea of the perceptions and knowledge‐level of diet/foodservice‐related healthcare workers about dysphagia. Subjects included foodservice workers, including food preparers and food deliverers at a large healthcare facility in the Southwestern United States. A total sample size of n=51 surveys was collected and analyzed.FindingsGiven the means from this sample group, healthcare foodservice workers are lacking in some areas of knowledge concerning dysphagia patients, and their dietary needs. Education and training seem indicated, as the number of patients suffering from some degree of dysphagia is only going to increase as the US population ages.Originality/valueMillions of Americans currently suffer from at least some degree of dysphagia. This number is expected to increase as the Baby Boomer generation reaches retirement age. The USA will be populated by more elderly people than ever before, and will thus host more individuals suffering from swallowing impairment. This paper adds insights to the subject.

Complementary and Alternative Medicine Treatments Among Stroke Patients in India

Background: Complementary and alternative medicine (CAM) is commonly used by persons with stroke throughout the world, particularly in Asia. Objective: The objectives of this study were to determine the frequency of CAM use and the factors that predict the use of CAM in stroke patients. Methods: This study was carried out in the stroke units of Christian Medical College, Ludhiana, and Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, from June 2010 to December 2010. Participants were interviewed using a structured questionnaire (≥6 months post stroke). Outcomes were assessed using a modified Rankin Scale (mRS). Results: Three hundred fourteen stroke patients were interviewed; mean age was 57.4 ± 12.9 years, and 230 (73.2%) patients were men. Of 314 patients, 114 (36.3%) had used the following CAM treatments: ayurvedic massage, 67 (59.3%); intravenous fluids, 22 (19.5%); herbal medicines, 17 (15%); homeopathy, 15 (13.3%); witchcraft, 3 (2.7%); acupuncture, 3 (2.7%); opium intake, 10 (8.8%); and other nonconventional treatments, 10 (8.8%). Patients with severe stroke (P < .0001), limb weakness (P < .0001), dysphagia (P = .02), dyslipidemia (P = .007), hypertension (P = .03), or hemorrhagic stroke (P <.0001) and patients with poor outcome (mRS >2; P < .0001) often used CAM treatments. Conclusion: More than one-third of the patients in this study opted for CAM. Presence of limb weakness, dysphagia, dyslipidemia, hypertension, hemorrhagic stroke, severe stroke, and poor outcome predicted the use of CAM.

Main Taste Effects on Swallowing Apnea Duration in Healthy Adults

This study examined swallowing apnea duration (SAD) and respiratory phase patterns as a function of taste, tastes combined with barium, age, and genetic taste group. Prospective group design. University medical center. Eighty healthy adult women were identified as nontasters and supertasters and equally comprised 2 age groups: 18 to 35 years (n = 40) and 60+ years (n = 40). The KayPentax Swallowing Signals Lab was used to acquire SAD and respiratory phase patterns via nasal cannula during randomized 5-mL swallows of water, 1.0 M sucrose (sweet), 1.0 M sodium chloride (salty), and 0.032 M caffeine (bitter) alone and mixed with barium. The SAD and respiratory patterns were analyzed in a linear mixed model and a binary logistic regression generalized estimating equation model, respectively. A significant main effect of age was found (P = .007). Older women demonstrated longer SAD than younger women. There were no significant effects of taste or genetic taste group on SAD. There was a significant interaction between barium and supertaster status; SAD was shorter in supertasters when barium was included. There were no significant differences in respiratory patterns between age groups, genetic taste groups, or among taste stimuli. Advanced age elicited longer SAD, a robust finding in repeated investigations from multiple laboratories. Main tastes did not affect SAD or respiratory phase patterns. Genetic taste group altered SAD when barium was combined with the taste. That is, taste + barium shortened SAD in supertasters. This finding may affect clinical management of dysphagia patients and warrants further investigation.

Relationship between esophageal contraction patterns and clearance of swallowed liquid and solid boluses in healthy controls and patients with dysphagia

Non-obstructive dysphagia patients prove to be a difficult category for clinical management. Esophageal high-resolution manometry (HRM) is a novel method, used to analyze dysphagia. However, it is not yet clear how findings on HRM relate to bolus transport through the esophagus. Twenty healthy volunteers and 20 patients with dysphagia underwent HRM and videofluoroscopy in a supine position. Each subject swallowed five liquid and five solid barium boluses. Esophageal contraction parameters and bolus transport were evaluated with HRM and concurrent videofluoroscopy. Stasis of liquid and solid barium boluses occurred in patients and in healthy volunteers in 64% and 41% and in 84% and 82% of the swallows, respectively. Overall, 70% of the liquid and 72% of the solid bolus swallows were followed by a peristaltic contraction, the difference not being statistically significant. Statistically significant associations were found for transition zone length of liquid and solid boluses, and for DCI and distal contraction amplitudes for liquid stasis. No correlation was found between the degree of stasis and other manometric parameters. Stasis of both liquid and solid boluses occurs frequently in patients and in controls and can be regarded as physiological. Motility patterns can predict the effectiveness of bolus transit and level of stasis to some degree but the relationship between esophageal motility and transit is complex and far from perfect. Esophageal manometry is therefore currently deemed unfit to be used for the prediction of bolus transit, and should rather be used for the identification of treatable esophageal motility disorders.

Food for Thought

Our professional American Speech-Language-Hearing Association (ASHA) guidelines state, if a speech-language pathologist suspects on the basis of the clinical history that there may be an esophageal disorder contributing to the patient's dysphagia, then “An esophageal screening can be incorporated into most [videofluoroscopic swallowing studies, or] VFSS” (ASHA, 2004). However, the esophageal screen has not been defined by ASHA or by the American College of Radiology. This “Food for Thought” column suggests deglutologists work together to determine the procedure and expected outcome for the esophageal screen so that there is acceptance and consensus among the multidisciplinary team members who evaluate patients with dysphagia.

P-0008 Follow-up Results of Expendable Metal Stents for Malignant Esophageal Obstruction and Fistulae in 177 Patients

ABSTRACT Introduction Expendable metal stents palliate malignant esophageal obstruction and fistulae in most cases, but complications and failures have not been well described in cardiac cancer with esophageal invasion as well as esophageal and lung cancer. Methods Over a ten-year period, 202 stents were placed in 177 patients with malignant esophageal obstruction and fistulae from esophageal cancer, lung cancer or Cardiac cancer with esophageal invasion. Early and late complications, duration of palliation, and reintervention were evaluated. Results A total of 202 expandable metal stents were placed in 177 patients for malignant dysphagia caused by esophageal cancer (52.5%), lung cancer (35.6%), or cardiac cancer (11.9%). The tumor locations were proximal in 5, mid in 85, and distal in 88. The mean age of patients was 66.75 years (range, 37 to 89 years); 154 were men, and 70 patients had stage IV disease. In most patients need an admission (162 to 177, 91.5%), and average length of admission was 19.7 days. 29 of the 202 cases (14.4%) who achieved early clinical success with stent insertion had long-term clinical failure. The most common causes of late clinical failure were tumor ingrowth and overgrowth (15 patients, 7.4%), followed by stent migration (14 patients, 6.9%). Major complications occurred in 1 patient diagnosed esophageal cancer stage IV. After palliative esophageal stent insertion, he expired of aspiration pneumonia was caused by septic shock. When comparing the esophageal, lung, and cardiac caner groups, age, gender, fistula status, and location were significantly different from each other. And complications were correlated to failure and type of reintervention. Conclusion Expandable metal stents offer excellent palliation of malignant obstruction, but recurrent obstruction requiring reintervention is common. And in radiation induced esophageal stricture group, major complications were not observed, but in broncho-esophageal fistula subgroup, major complications were observed.

An impedance‐manometry based method for non‐radiological detection of pharyngeal postswallow residue

Postswallow residue is indicative of impaired pharyngeal bolus clearance. The integrated nadir impedance to impedance ratio (iZn/Z) is a novel functional variable that can be derived using automated impedance manometry (AIM). In this study, the postswallow pharyngeal iZn/Z was evaluated as a potential correlated postswallow residue and therefore predictor of ineffective swallowing. Optimal iZn/Z criteria were determine using a database of 50 randomly selected bolus swallows recorded with impedance, manometry, and videofluoroscopy. The iZn/Z was derived for a region of interest (ROI), spanning the mid-point of the pharyngeal stripping wave to the upper esophageal sphincter proximal margin, and from 0.25 to 1.25 s after the peak of the pharyngeal stripping wave. Videofluorscopy was scored by four experts using a six-point bolus residue scale (BRS) score. Optimized criteria for iZn/Z were then applied to a much larger database of 225 swallows scored for residue by one expert observer. Among individual database, swallows iZn/Z was significantly correlated with average expert BRS score (r = 0.748, P < 0.0001). An iZn/Z of ≥ 500 was optimally predictive of swallows with residue defined by a BRS score of 4 or more. Within the larger cohort, iZn/Z was higher in dysphagia patient swallows compared with controls [2 (1, 4) vs 1 (1, 3), P < 0.005] and swallows with an iZn/Z ≥ 500 had higher bolus residue scores [4 (1, 6) vs 2 (1, 4), P < 0.001]. The AIM derived iZn/Z is an easily determined objective non-radiological marker of clinically relevant postswallow residue and therefore has potential diagnostic relevance as a predictor of ineffective swallowing.

A rare case of dysphagia and palpitation caused by the compression exerted by an enormous mediastinal lipoma

A 65-year-old woman presented with mild dysphagia, weight loss and intermittent palpitation. Chest radiograph revealed a large opacity in the right lower lung field. Subsequent CT scan showed a large posterior mediastinal lipoma extending from the level of the aortic arch to the thoracoabdominal junction. After thoracoscopic resection, the patient's dysphagia and palpitation were resolved. After a follow-up of 2 years, the patient has had no evidence of recurrence.

Abstract 196: Compounded Point-Scoring Of Dysphagia Risk Factors Predict Clinical Dysphagia In An Acute Care Hospital Setting

Compounded Point-Scoring Of Dysphagia Risk Factors Predict Clinical Dysphagia In An Acute Care Hospital Setting Introduction Dysphagia places patients at risk for malnutrition, dehydration, and pulmonary aspiration; reduces quality of life; and lengthens hospitalization. The published literature describes individual dysphagia risks factors (DRF) . We felt that in many patients, the risk would be given by the number and types of DRF. Further, each risk factor could have its own independent contribution to the dysphagia. Hypothesis Can the risk of dysphagia be identified with a simple screening questionnaire where the clinical DRF are numerically weighed-scored, and later compounded? Methods Individual DRF (n=21) were each weighed from 1 to 5. The decision on the assigned score was given by 3 individual experts, the values averaged. • A score of 0 means that no dysphagia risk factors were present. • A score 1-4 means that some DRF are present, but the risk probably low. It prompts the bedside nurse to administer standardized swallowing trials. (video available in vimeo.com/speechpathology). • A score ≥5 signifies high risk for aspiration. The patient is placed in full-NPO status, and the Speech Language Pathology (SLP) service is consulted for a bedside swallowing evaluation (BSE). Patients admitted to floors where stroke patients would be admitted more commonly were given the Swallowing Safety Screening (SSS) by the trained bedside nurse. The SSS has 2 components the 1) scoring, and 2) the administration of swallowing trials. Here, we report on the scoring component of the SSS. Results SSS was reviewed for 357 patients (n=357) who were referred to the SLP. Patients on SLP’s caseload were reviewed in a blinded, time-limited, non-randomized fashion. Data was collected for patients for whom a SSS had been completed, and a BSE had been triggered (n=133). Of patients in this subset (n=114) who scored ≥5 on the SSS, 70% were judged positive for the presence of dysphagia, 30% were negative. Further analysis of the data reveals that the mean SSS score for negative dysphagia diagnoses is &lt;6.1, and for positive dysphagia diagnoses is &gt;7.95. The confidence intervals (95%) are 1.29 and 1.4, respectively. Using z statistics, the probability of getting this separation of the data by chance is p =0.00014. Conclusions It is possible to identify dysphagia patients using a questionnaire where the DRF are given a numerical weight and then summated. There is a point where the score of the DRF adds such clinical weight that dysphagia is identified or predicted.

Clinical study on tongyan spray for post-stroke dysphagia patients: a randomized controlled trial.

To observe the effectiveness and safety of Tongyan spray composed of Chinese medicine for post-stroke dysphagia patients. One hundred and twenty-two post-stroke dysphagia patients were randomly assigned to the treatment group (61 cases) and the control group (61 cases). Basic treatment was given to both groups, with Tongyan spray additionally used in oropharynx for the treatment group, and the placebo used for the control group. After 28-day treatment, the clinical effect and safety were evaluated according to the standard swallowing assessment (SSA) scale. One patient dropped out in each group, and 120 patients reached the final analysis of the study. The total effective rate for the treatment group was 71.7% (43/60), higher than 46.7% (28/60) in the control group (P<0.05), and the improvement on SSA scores of the two groups were significantly different after treatment (P<0.05). For grade 1 dysphagia patients (completely depending on nasogastric tube), the effective rate of the treatment group was 40.9% (9/22), and 12.5% (2/16) of the control group, without significant difference (P>0.05), while the improvement of SSA score was significantly different between the two groups after treatment (P<0.05). For grade 2-3 dysphagia patients (oral and nasogastric tube feeding), the total effective rate of the treatment group was 89.5% (34/38), higher than 59.1% (26/44) in the control group (P<0.05), and also the improvement on SSA scores was significantly different between the two groups after treatment (P<0.05). Tongyan spray was an effective and safe method for post-stroke dysphagia patients.

Choking Carries Significant Risk for Residents and Facilities

Choking Carries Significant Risk for Residents and Facilities

On the 20th Anniversary of the Dysphagia Research Society

It is with great pleasure that we present this special issue of Dysphagia in commemoration of the 20th Anniversary of the formation of Dysphagia Research Society (DRS). It is hard to believe that already 20 years have passed since that cold early November day in 1992 when over 230 of us, interested in the care of dysphagia patients and engaged in research to improve this care, congregated in the inaugural DRS meeting in Milwaukee, Wisconsin. Participants came from a number of countries from Europe, Asia, South and North America, and Australasia and represented disciplines such as Gastroenterology, Speech Language Pathology, Otolaryngology, Neurology, Rehabilitation Medicine, and Mechanical Engineering. Over the past 20 years, the society has vigorously pursued its goals of enhancing and encouraging research pertinent to normal and disordered swallowing and related functions. It has attracted new investigators to the field and, more importantly, encouraged interdisciplinary research. It has effectively promoted the dissemination of knowledge related to normal and disordered swallowing and provided a multidisciplinary forum for presentation of research while fostering new methodologies and instrumentation in dysphagia research and its clinical applications. These goals were in concordance with those of our journal, which soon became the official organ of the Dysphagia Research Society and other dysphagia-related societies that subsequently were formed in Japan and Europe. It has been a productive and rewarding partnership. The Dysphagia journal and the Society have been effective partners to promote the field. Through this partnership, patients, clinicians, and investigators have been heard. New findings in research and treatment have been presented. Many important milestones have been passed. Parallel to the growth of the journal and the Society, dysphagia care and research has emerged from obscurity, the multidisciplinary nature of swallowing and its disorders has been recognized, and the importance of comprehensive training that incorporates the entire field of deglutition has been acknowledged. There is talk about the need for development of a new discipline: ‘‘Deglutology,’’ a unique discipline serving as a home for clinicians and investigators irrespective of their original field of training. This discipline would focus specifically on advancing the field of deglutology for the benefit of the ever-increasing number of dysphagia patients world-wide in need of better prevention and treatment. A great deal has been accomplished in 20 years and these accomplishments have paved the way to meet the challenges ahead. We congratulate the DRS members and leadership for their accomplishments and service to the field of deglutition and deglutition disorders. Happy 20th anniversary.

A rare case of dysphagia and palpitation caused by the compression exerted by an enormous mediastinal lipoma

A 65-year-old woman presented with mild dysphagia, weight loss and intermittent palpitation. Chest radiograph revealed a large opacity in the right lower lung field. Subsequent CT scan showed a large posterior mediastinal lipoma extending from the level of the aortic arch to the thoracoabdominal junction. After thoracoscopic resection, the patient's dysphagia and palpitation were resolved. After a follow-up of 2 years, the patient has had no evidence of recurrence.

Esophageal squamous cell carcinoma in children: A case presentation and review of an unusual entity

Squamous cell carcinoma (SCC) of the esophagus usually occurs between the 4th and 6th decades of life. Esophageal SCC in children is an extremely rare entity – only a few pediatric and adolescent patients have been reported. Herein we present a 17-year-old male progressive dysphagia patient that developed SCC of the esophagus, as well as a literature review of esophageal SCC in pediatric and adolescent patients.

Investigation of compensatory postures with videofluoromanometry in dysphagia patients

To investigate the effectiveness of head compensatory postures to ensure safe oropharyngeal transit. A total of 321 dysphagia patients were enrolled and assessed with videofluoromanometry (VFM). The dysphagia patients were classified as follows: safe transit; penetration without aspiration; aspiration before, during or after swallowing; multiple aspirations and no transit. The patients with aspiration or no transit were tested with VFM to determine whether compensatory postures could correct their swallowing disorder. VFM revealed penetration without aspiration in 71 patients (22.1%); aspiration before swallowing in 17 patients (5.3%); aspiration during swallowing in 32 patients (10%); aspiration after swallowing in 21 patients (6.5%); multiple aspirations in six patients (1.9%); no transit in five patients (1.6%); and safe transit in 169 patients (52.6%). Compensatory postures guaranteed a safe transit in 66/75 (88%) patients with aspiration or no transit. A chin-down posture achieved a safe swallow in 42/75 (56%) patients, a head-turned posture in 19/75 (25.3%) and a hyperextended head posture in 5/75 (6.7%). The compensatory postures were not effective in 9/75 (12%) cases. VFM allows the speech-language the-rapist to choose the most effective compensatory posture without a trial-and-error process and check the effectiveness of the posture.